{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T00:32:54Z","timestamp":1790037174925,"version":"4.0.1"},"reference-count":61,"publisher":"American Medical Association (AMA)","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"Importance<\/jats:title>Deep brain stimulation of the subthalamic nucleus (STN-DBS) improves quality of life (QOL) in patients with advanced Parkinson disease (PD). However, controlled studies with more than 3 years of follow-up are lacking.<\/jats:p><\/jats:sec>Objective<\/jats:title>To investigate the long-term effects of STN-DBS on QOL compared with standard-of-care medication (MED).<\/jats:p><\/jats:sec>Design, Setting, and Participants<\/jats:title>In this prospective, observational, quasi-experimental, longitudinal nonrandomized controlled trial, 183 patients were screened for eligibility and 167 were enrolled from March 1, 2011, to May 31, 2017, at 3 European university centers. Propensity score matching for demographic and clinical characteristics was applied to 108 patients with PD (62 in the STN-DBS group and 46 in the MED group), resulting in a well-balanced, matched subcohort of 25 patients per group. Data analysis was performed from September 2022 to January 2023.<\/jats:p><\/jats:sec>Exposure<\/jats:title>Treatment for PD of STN-DBS or MED.<\/jats:p><\/jats:sec>Main Outcomes and Measures<\/jats:title>Assessments included Parkinson\u2019s Disease Questionnaire 8 (PDQ-8), Unified PD Rating Scale\u2013motor examination, Scales for Outcomes in PD\u2013activities of daily living (ADL) and motor complications, and levodopa-equivalent daily dose. Within-group longitudinal outcome changes, between-group differences, and correlations of change scores were analyzed.<\/jats:p><\/jats:sec>Results<\/jats:title>The study population in the analysis included 108 patients (mean [SD] age, 63.7 [8.3] years; 66 [61.1%] male). At 5-year follow-up, PDQ-8 and ADL worsened only in the MED group (PDQ-8 change, \u221210.9; 95% CI, \u221219.0 to \u22122.7; P<\/jats:italic>\u2009=\u2009.01; ADL change: \u22122.0; 95% CI, \u22123.1 to \u22120.8; P<\/jats:italic>\u2009=\u2009.002), whereas both outcomes remained stable in the STN-DBS group (PDQ-8 change, \u22124.3; 95% CI, \u221213.2 to 4.7; P<\/jats:italic>\u2009=\u2009.34; ADL change, \u22120.8; 95% CI, \u22122.5 to 1.0; P<\/jats:italic>\u2009=\u2009.38). Changes in PDQ-8 and ADL correlated moderately (r<\/jats:italic>s<\/jats:sub>\u2009=\u2009.40, P<\/jats:italic>\u2009=\u2009.008). Furthermore, STN-DBS outcomes were favorable for motor complications (median difference in change scores between STN-DBS and MED, \u22122.0; 95% CI, \u22124.0 to \u22121.0; P<\/jats:italic>\u2009=\u2009.003), mobility (\u22121.0; 95% CI, \u22122.0 to 0; P<\/jats:italic>\u2009=\u2009.03), and levodopa-equivalent daily dose reduction (\u2212821.4; 95% CI, \u22121111.9 to \u2212530.8; P<\/jats:italic>\u2009&amp;lt;\u2009.001).<\/jats:p><\/jats:sec>Conclusions and Relevance<\/jats:title>This study provides evidence of differences in QOL outcomes at 5-year follow-up between STN-DBS (stable) and MED (worsened), mainly driven by the favorable effect of STN-DBS on mobility (class IIb evidence). The association between changes in QOL and ADL, but not motor impairment or complications, highlights the relative importance of ADL outcomes for long-term DBS assessments.<\/jats:p><\/jats:sec>Trial Registration<\/jats:title>German ClinicalTrials Registry: DRKS00006735<\/jats:ext-link><\/jats:p><\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2023.52177","type":"journal-article","created":{"date-parts":[[2024,1,18]],"date-time":"2024-01-18T11:00:57Z","timestamp":1705575657000},"page":"e2352177","source":"Crossref","is-referenced-by-count":48,"title":["Neurostimulation for Advanced Parkinson Disease and Quality of Life at 5 Years"],"prefix":"10.1001","volume":"7","author":[{"given":"Stefanie T.","family":"Jost","sequence":"first","affiliation":[{"name":"University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Neurology, Cologne, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Salima","family":"Aloui","sequence":"additional","affiliation":[{"name":"University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Neurology, Cologne, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julian","family":"Evans","sequence":"additional","affiliation":[{"name":"Department of Neurology and Neurosurgery, Salford Royal NHS Foundation Trust, Manchester, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Keyoumars","family":"Ashkan","sequence":"additional","affiliation":[{"name":"Parkinson Foundation International Centre of Excellence, King\u2019s College Hospital, London, UK"},{"name":"Academic Health Science Centre, University of Manchester, Greater Manchester, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna","family":"Sauerbier","sequence":"additional","affiliation":[{"name":"University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Neurology, Cologne, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandra","family":"Rizos","sequence":"additional","affiliation":[{"name":"Parkinson Foundation International Centre of Excellence, King\u2019s College Hospital, London, UK"},{"name":"Academic Health Science Centre, University of Manchester, Greater Manchester, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jan Niklas","family":"Petry-Schmelzer","sequence":"additional","affiliation":[{"name":"University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Neurology, Cologne, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandra","family":"Gronostay","sequence":"additional","affiliation":[{"name":"University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Neurology, Cologne, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gereon R.","family":"Fink","sequence":"additional","affiliation":[{"name":"University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Neurology, Cologne, Germany"},{"name":"Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM-3), Research Centre J\u00fclich, J\u00fclich, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Veerle","family":"Visser-Vandewalle","sequence":"additional","affiliation":[{"name":"University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Stereotactic and Functional Neurosurgery, Cologne, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angelo","family":"Antonini","sequence":"additional","affiliation":[{"name":"Department of Neurosciences (DNS), Padova University, Padova, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Monty","family":"Silverdale","sequence":"additional","affiliation":[{"name":"Department of Neurology and Neurosurgery, Salford Royal NHS Foundation Trust, Manchester, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lars","family":"Timmermann","sequence":"additional","affiliation":[{"name":"Department of Neurology, University Hospital Giessen and Marburg, Campus Marburg, Marburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pablo","family":"Martinez-Martin","sequence":"additional","affiliation":[{"name":"Center for Networked Biomedical Research in Neurodegenerative Diseases (CIBERNED), Carlos III Institute of Health, Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"K. Ray","family":"Chaudhuri","sequence":"additional","affiliation":[{"name":"Parkinson Foundation International Centre of Excellence, King\u2019s College Hospital, London, UK"},{"name":"Academic Health Science Centre, University of Manchester, Greater Manchester, UK"},{"name":"Institute of Psychiatry, Psychology and Neuroscience, King\u2019s College London, London, UK"},{"name":"NIHR Mental Health Biomedical Research Centre and Dementia Biomedical Research Unit, South London and Maudsley NHS Foundation Trust and King\u2019s College London, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Haidar S.","family":"Dafsari","sequence":"additional","affiliation":[{"name":"University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Neurology, Cologne, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"International Parkinson and Movement Disorders Society Non-Motor Parkinson\u2019s Disease Study Group and 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